A six year old girl presented to the Orthopaedic department with a five day history of right hip pain, fevers and difficulty weight bearing. There was no history of trauma or any recent illness. The patient was of Somail origin but there was no recent history of travel or infectious contacts and no significant past medical history. On examination she had a temperature of 39.5 degrees Celsius and the right hip was held in flexion, with localised anterior joint line tenderness. Both passive and active movements of her hip were painful and restricted. Examination of her left hip, knees and ankles was normal. Examination of her abdomen revealed mild tenderness in the right iliac fossa. Blood tests showed a neutrophilia with left shift and a raised C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Sickle cell screen was negative and initial pelvic x-rays were normal. She was diagnosed with hip septic arthritis and an open washout of the hip joint was performed. Two millilitres of blood stained fluid was aspirated and the patient was commenced on intravenous (IV) antibiotics. The following day the patient remained pyrexial and the CRP and ESR continued to be raised. A second open washout of the right hip was performed but no pus or fluid was aspirated. Blood and joint fluid cultures were subsequently positive for staphylococcus aureus. A magnetic resonance imaging (MRI) scan of the right hip was performed which showed collections of the right iliacus and distal iliopsoas, with abnormal marrow signal in the right iliac wing consistent with osteomyelitis (). The patient was diagnosed with iliac osteomyelitis and transferred to Manchester Children’s Hospital were she underwent exploration of the right iliopsoas abscess. This revealed a large collection of pus and some necrotic muscle, which was thoroughly washed out and debrided. She gradually made a recovery and was eventually discharged home after a total of 30 days. Oral antibiotics were continued on an outpatient basis for a further 28 days. On follow-up, one month later she had made a full recovery, with a normal gait and a full range of movement of her right hip.